A signature of maternal anti-fetal rejection in spontaneous preterm birth: chronic chorioamnionitis, anti-human leukocyte antigen antibodies, and C4d

• Published in: PloS one 2011-02, Vol.6 (2), p.e16806-e16806
• Main Authors: Lee, JoonHo, Romero, Roberto, Xu, Yi, Kim, Jung-Sun, Topping, Vanessa, Yoo, Wonsuk, Kusanovic, Juan Pedro, Chaiworapongsa, Tinnakorn, Hassan, Sonia S, Yoon, Bo Hyun, Kim, Chong Jai
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Antibodies; Antibodies - blood; Antigens; Birth; Cardiovascular disease; Childbirth & labor; Childrens health; Chorioamnionitis; Chorioamnionitis - blood; Chorioamnionitis - etiology; Chorioamnionitis - immunology; Chronic Disease; Complement C4b - analysis; Coronary vessels; Cross-Sectional Studies; Deposition; Endothelium; Etiology; Female; Fetus - immunology; Fetuses; Graft rejection; Graft Rejection - immunology; Graft-versus-host reaction; Gynecology; Histocompatibility antigen HLA; Histocompatibility, Maternal-Fetal - immunology; Histocompatibility, Maternal-Fetal - physiology; HLA antigens; HLA Antigens - immunology; Humans; Immunoglobulins; Immunohistochemistry; Infant, Newborn; Labor; Leukocytes; Lymphocytes; Maternal-Fetal Exchange - immunology; Medicine; Obstetrics; Peptide Fragments - analysis; Peptide Fragments - blood; Preeclampsia; Pregnancy; Premature birth; Premature Birth - blood; Premature Birth - diagnosis; Premature Birth - etiology; Premature Birth - immunology; Premature infants; Regression analysis; Rejection; Transplantation; Transplants & implants; Umbilical vein; White blood cells; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0016806

Chronic chorioamnionitis is found in more than one-third of spontaneous preterm births. Chronic chorioamnionitis and villitis of unknown etiology represent maternal anti-fetal cellular rejection. Antibody-mediated rejection is another type of transplantation rejection. We investigated whether there was evidence for antibody-mediated rejection against the fetus in spontaneous preterm birth. This cross-sectional study included women with (1) normal pregnancy and term delivery (n = 140) and (2) spontaneous preterm delivery (n = 140). We analyzed maternal and fetal sera for panel-reactive anti-HLA class I and class II antibodies, and determined C4d deposition on umbilical vein endothelium by immunohistochemistry. Maternal anti-HLA class I seropositivity in spontaneous preterm births was higher than in normal term births (48.6% vs. 32.1%, p = 0.005). Chronic chorioamnionitis was associated with a higher maternal anti-HLA class I seropositivity (p